Physical Status codes: PS I: animal with no organic disease, or in whom the disease is localized and is causing no systemic disturbance (eg, healthy 3 yr old castration) PS II: animal with mild systemic disturbance which may or may not be associated with the surgical complaint (anemic, obese, geriatric) PS III: animal with moderate systemic disturbance which may or may not be associated with surgical complaint, and which usually interferes with normal activity but is not incapacitating (eg mitral insufficiency) PS IV: animal with extreme systemic disturbance(s) which is incapacitating and a constant threat to life and seriously interferes with normal functioning (uncompensated mitral insufficiency, severe pneumothorax from lung laceration, etc) PS V: animal presented moribund and not expected to live 24 hrs without surgery immediately. PS E: emergency in any classification - always a greater risk. Equipment: 500 ml NormR for most cases; 250 ml for cases under 10 kg. Venoset (15 dr/ml) or microdrip (60 dr/ml - for animals under 10 kg) IV cath - 18 ga for large dogs, 20 for cats and small dogs. Rebreathing bag - 1 L/10 kg; small hoses for animals under 10 kg Non-rebreathing system for animals under 2 kg - O2 flows at 600 ml/kg (3x RMV) At the end of the procedure: let animal breathe oxygen 10-15 ml/kg at 10-20 bpm. when to extubate: when jaw tone is increased, other reflexes are brisk, signs of waking are obvious. Swallowing is preferable but not required. Leave IV cath in until told to remove it. Dog protocols: IM pre-ops: give 15-20 min prior to insertion of IV cath and induction. 1. atropine .02 mg/kg and meperidine 8 mg/kg 2. atropine .02 mg/kg and oxymorphone .1 mg/kg 3. atropine .2 mg/kg and hydromorphone .2 mg/kg 4. acepromazine .02-.1 mg/kg 5. atropine .02 mg/kg and ace .02-.06 mg/kg and oxymorphone .05 mg/kg 6. atropine .02 mg/kg and buprenorphine .01 mg/kg 7. atropine .02 mg/kg and acepromazine .02-.04 mg/kg and buprenorphine .006-.01 mg/kg 8. atropine .02 mg/kg and ace .02-.04 mg/kg and butorphanol 0.1-0.4 mg/kg 9. atropine .02 mg/kg and butorphanol 0.5 mg/kg * in any of the above - can substitute glycopyrrolate .01 mg/kg for atropine. Dog induction: -place cephalic IV catheter -2.5% thiopental, given in a 2 mg/kg bolus while someone is monitoring pulse and checking for arrhythmias. wait 15 seconds. give boluses of 2-4 mg/kg until ready to intubate. -intubate, attach y-piece and hoses, flush w/O2, inflate cuff -start O2 at 100 ml/kg/min and 3% halo or iso -tie in tube, ventilate as needed -place esoph.steth, eye goo, etc. when stable in sx plane, go to low flow O2 5-6 ml/kg/min. Sick dog protocols: -place IV cath -start fluids - caution if heart dz! -IM premeds are avoided in sick dogs -induction: narcotic induction: atropine 0.01 mg/kg OR glycopyrrolate .005 mg/kg IV (anticholinergic only if needed) oxymorphone .1 mg/kg or hydromorphone .2 mg/kg or fentanyl .005 mg/kg IV diazepam .2-.5 mg/kg IV lidocaine 2% 2 mg/kg IV You may have to give additional narcotic to intubate - start with 1/2 the original dose narcotic/etomidate induction: atropine 0.01 mg/kg OR glycopyrrolate .005 mg/kg IV (anticholinergic only if needed) oxymorphone .1 mg/kg or hydromorphone .2 mg/kg or fentanyl .005 mg/kg IV diazepam .2-.5 mg/kg IV etomidate 0.2 - 1.5 mg/kg IV ketamine/diazepam induction: atropine 0.01 mg/kg OR glycopyrrolate .005 mg/kg IV ketamine 10 mg/kg IV and diazepam .5 mg/kg give 1/2 the ketamine and all the diazepam. Then give the rest of the ketamine to effect. Ketamine is controversial in dogs, do not use without taking to anesthesia. propofol/diazepam induction: propofol 2 mg/kg and diazepam .2-.5 mg/kg IV continue with propofol at 1-2 mg/kg until intubation possible may cause hypotension! mask induction with isoflurane - self explanatory Sick dog maintenance: after intubation: high flow O2 100 ml/kg/min; then low flow 5-6 ml/kg/min unless O2 usei s higher, then increase flow (bag will empty and no leaking) Iso and O2 ok as long as BP adequate. If BP poor, decrease or turn off inhalant and use injectable maintenance: narcotic maintenance: oxymorphone .025-.05 mg/kg IV boluses diazepam .2 mg/kg IV boluses give as needed to maintain sedation and anesthesia Fentanyl infusion: CRI .0007 - .0015 mg/kg/min diazepam .2 mg/kg IV boluses PRN for sedation local anesthetic line blocks for adjunctive anesthesia. -- Sight Hounds: these dogs have a smaller volume of distribution and lower thio clearance. preop if needed: glycopyrrolate .01 mg/kg IM and oxy .1 mg/kg or hydro .2 mg/kg IM induction: propofol 2 mg/kg IV, repeated until intubation possible, +/- diazepam .2-.5 mg/kg IV; OR diazepam .5 mg/kg and ketamine 10 mg/kg IV. give half the ketamine, all the diazepam, then ketamine to effect; OR: oxymorphone .1 mg/kg OR fentanyl .005 mg/kg IV AND diazepam .2-.5 mg/kg IV +/- etomidate .2 mg/kg IV maintenance - iso & O2. -- remember - all potent inhalants can trigger malignant hyperthermia - watch for hyperthermia, surface heat, tachypnea, tachycardia, hypertension, increased sodalime consumption, etc. -- Mast cell tumor protocol: to protect against potential histamine release and subsequent vasodilation/hypotension, airway swelling, bronchiolar constriction, gastric acid secretion. -avoid using narcotics if possible -premed with glycopyrrolate .01 mg/kg and benadryl 2 mg/kg IM -induction/maintainance drugs: thiopental, diazepam, propofol, etomidate -after induction: give cimetidine 10 mg/kg IV and dexamethasone .2-.5 mg/kg IV VERY SLOWLY -fentanyl or oxymorphone ok intraoperatively if needed after histamine blockers are given. C-section protocols: 1. epidural analgesia 2. oxy and diazepam sedation IV with lidocaine line block. reverse neonates with naloxone and give dopram to stimulate respiration 3. thiopental induction with light inhalant. 4. mask induction with isoflurane 5. propofol IV as boluses or CRI 6. ketamine and diazepam use glycopyrrolate if anticholinergic needed Canine chemical restraint protocols: 1. morphine 0.5 - 2+ mg/kg IM and ace .05-.1 mg/kg IM and atropine .02 mg/kg IM. this is sedation of choice for aggressive dogs. watch for vomiting, may need to remove muzzle. 2. butorphanol 0.1 mg/kg IV and ace .01 mg/kg IV. can substitute diazepam .25 -.5 mg/kg IV for the acepromazine. can repeat if needed; double the dose if using IM. works well for short procedures, about 15 minutes; especially good for chest rads since no panting. butorphanol is best for debilitated animals where respiratory depression is a concern. 3. ketamine 5 mg/kg IV and diazepam .5 mg/kg iv and atropine .01 mg/kg iv 4. oxymorphone .1 mg/kg iv or hydromorphone .2 mg/kg iv and diazepam .5 mg/kg IV. add glycopyrrolate .005 mg/kg IV if needed. may cause excitement; best for debilitated animals where respiratory depression is not a concern. 5. propofol 1-2 mg/kg IV boluses and diazepam 0.25-.5 mg/kg IV. watch for resp. depression, administer propofol slowly, may cause severe hypotension. Postop analgesia: 1. buprenorphine .006-.01 mg/kg IM/IV 2. butorphanol .02-.2 mg/kg IV; .5 mg/kg IM 3. morphine .2-2 mg/kg im,iv 4. oxymorphone .04-.12 mg/kg IM, IV 5. hydromorphone .1-.2 mg/kg IM, IV Anesthesia for cats: pre-op: 5 minutes before induction - atropine .02 mg/kg and ketamine 8 mg/kg IM. IM ketamine can *sting*. use both drugs in same syringe. induction: ketamine 2 mg/kg and diazepam .5 mg/kg IV injected slowly while someone monitors pulse. intubation - use lidocaine spray high flow O2 - 100 ml/kg with 1.5% halo or iso NB: ketamine may cause apnea or apneustic breathing - assist ventilation as needed until adequate, regular ventilation is apparent. low flow: 5-6 ml/kg/min; adjust inhalant accordingly. sick cat protocol: induction: 1. diazepam .2-.5 mg/kg IV and etomidate .2-1.5 mg/kg IV 2. atropine .01 mg/kg or glycopyrrolate .005 mg/kg IV; oxymorphone .1 mg/kg or fentanyl .005 mg/kg IV; diazepam .2-.5 mg/kg IV. May use etomidate .2 mg/kg IV. Lidocaine 1 mg/kg may be given IV or used topically. 3. ketamine 2 mg/kg IV and diazepam .2-.5 mg/kg IV 4. box or mask induction with isoflurane maintenance: intubate, start on 100% O2 at 100 ml/kg/min, then iso at 1.5% if BP is adequate. (reduce to low flow? not in handout) if hypotensive on iso use etomidate .2 mg/kg IV boluses or diazepam .2 mg/kg IV and/or oxymorphone .02-.05 mg/kg OR fentanyl .005 mg/kg IV as needed for analgesia and sedation. cat chemical restraint: 1. ketamine/xylazine mixture 1 ml/10 kg IM, 1 ml/50 kg IV; and atropine .02 mg/kg IM (premix 3 ml ketamine (100 mg/ml) with 1 ml xylazine (20 mg/ml) 2. ketamine 2-4 mg/kg IV and diazepam .2-.5 mg/kg IV and atropine .01 mg/kg IV if needed 3. butorphanol .1 mg/kg iv and ace .01 mg/kg IV - repeat if needed, double the dose if using IM. 4. propofol 1-2 mg/kg IV boluses and diazepam .25-.5 mg/kg IV. watch for hypotension and respiratory depression. Fluid therapy/blood loss: preop fluid balance evaluation - skin turgor, mms, CRT, HR, pulses. rehydration and electrolyte corrections best made pre-op! maintenance in awake animals: 2-4 ml/kg/hr. surgical maintenance 10 ml/kg/hr [and 20 ml/kg/hr for first hour to compensate for vasodilation due to drugs]. always adjust as needed in animals with heart disease to prevent volume overload! blood loss: check suction cannister, sponges, floor, etc. one soaked 4x4 holds 10 ml. replace 1ml blood with 3 ml crystalloid. serial pcv/ts as needed if concerned!